Retrocalcaneal bursitis is a condition characterized by tissue damage and inflammation of the retrocalcaneal bursa (a small fluid filled sac located at the back of the heel) causing pain in the heel region.

A bursa is a thin fluid filled sac found in various places throughout the body. Bursae are designed to reduce friction between adjacent layers of tissue and are filled with lubricating fluid. They are typically located in regions of the body where tissue layers may rub against each other or against bony prominences.

• Poor foot biomechanics (particularly flat feet)
• Inappropriate footwear (e.g. excessively tight fitting shoes)
• Muscle weakness (particularly the calf, quadriceps and gluteals)
• Muscle tightness (particularly the calf)
• Joint stiffness (particularly the ankle, subtalar joint or foot)
• Bony anomalies of the heel bone
• Inappropriate or excessive training or activity
• Inadequate recovery periods from sport or activity
• Inadequate warm up
• Inadequate rehabilitation following a previous Achilles injury
• Change in training conditions or surfaces
• Inappropriate running technique

• Inadequate fitness
• Poor pelvic and core stability
• Poor proprioception or balance
• Being overweight

• Patients typically experience pain at the back of the ankle and heel where the Achilles tendon attaches into the heel bone.
• Pain during activities requiring strong or repetitive calf contractions (often involving end of range ankle movements) such as walking (especially uphill), going up and down stairs, running, jumping or hopping (especially whilst wearing excessively tight shoes).
• Often pain may be worse with rest after these activities (especially that night or the following morning).

• The pain associated with this condition may 'warm up' with activity in the initial stages of injury.
• As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance.
• In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg.
• Other symptoms may include tenderness on firmly touching the affected bursa and swelling around the Achilles region.

A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose a retrocalcaneal bursitis.
Diagnosis may be confirmed with an ultrasound investigation, MRI or CT scan.

Treatment

Goals of treatment:

• To reduce pain
• To reduce inflammation
• To increase joint mobility
• Restore the level of function you had before the injury
• Increase muscle strength
• Promote healing

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